Diagnostic Tests

PPD test
  1. Read result 48 – 72 hours after injection.
  2. For HIV positive clients, in duration of 5 mm is considered positive
Bronchography
  1. Secure consent
  2. Check for allergies to seafood or iodine or anesthesia
  3. NPO 6-8 hours before the test
  4. NPO until gag reflex return to prevent aspiration
Thoracentesis – (Aspiration of fluid in the pleural space.)
  1. Secure consent, take V/S
  2. Position upright leaning on over bed table
  3. Avoid cough during insertion to prevent pleural perforation
  4. Turn to unaffected side after the procedure to prevent leakage of fluid in the thoracic cavity
  5. Check for expectoration of blood. This indicate trauma and should be reported to MD immediately.
Holter Monitor
  1. It is continuous ECG monitoring, over 24 hours period
  2. The portable monitoring is called telemetry unit
Echocardiogram
  1. Ultrasound to assess cardiac structure and mobility
  2. Client should remain still, in supine position slightly turned to the left side, with HOB elevated 15-20 degrees
Electrocardiography
  1. If the patient’s skin is oily, scaly, or diaphoretic, rub the electrode with a dry 4×4 gauze to enhance electrode contact.
  2. If the area is excessively hairy, clip it
  3. Remove client`s jewelry, coins, belt or any metal
  4. Tell client to remain still during the procedure
Cardiac Catheterization
  1. Secure consent
  2. Assess allergy to iodine, shellfish
  3. V/S, weight for baseline information
  4. Have client void before the procedure
  5. Monitor PT, PTT, and ECG prior to test
  6. NPO for 4-6 hours before the test
  7. Shave the groin or brachial area
  8. After the procedure : bed rest to prevent bleeding on the site, do not flex extremity
  9. Elevate the affected extremities on extended position to promote blood supply back to the heart and prevent thrombophlebitis
  10. Monitor V/S especially peripheral pulses
  11. Apply pressure dressing over the puncture site
  12. Monitor extremity for color, temperature, tingling to assess for impaired circulation.
MRI
  1. Secure consent,
  2. The procedure will last 45-60 minute
  3. Assess client for claustrophobia
  4. Remove all metal items
  5. Client should remain still
  6. Tell client that he will feel nothing but may hear noises
  7. Client with pacemaker, prosthetic valves, implanted clips, wires are not eligible for MRI.
  8. Client with cardiac and respiratory complication may be excluded
  9. Instruct client on feeling of warmth or shortness of breath if contrast medium is used during the procedure
UGIS – Barium Swallow
  1. Instruct client on low-residue diet 1-3 days before the procedure
  2. Administer laxative evening before the procedure
  3. NPO after midnight
  4. Instruct client to drink a cup of flavored barium
  5. X-rays are taken every 30 minutes until barium advances through the small bowel
  6. Film can be taken as long as 24 hours later
  7. Force fluid after the test to prevent constipation/barium impaction
LGIS – Barium Enema
  1. Instruct client on low-residue diet 1-3 days before the procedure
  2. Administer laxative evening before the procedure
  3. NPO after midnight
  4. Administer suppository in AM
  5. Enema until clear
  6. Force fluid after the test to prevent constipation/barium impaction
Liver Biopsy
  1. Secure consent,
  2. NPO 2-4 hrs before the test
  3. Monitor PT, Vitamin K at bedside
  4. Place the client in supine at the right side of the bed
  5. Instruct client to inhale and exhale deeply for several times and then exhale and hold breath while the MD insert the needle
  6. Right lateral post procedure for 4 hours to apply pressure and prevent bleeding
  7. Bed rest for 24 hours
  8. Observe for S/S of peritonitis
Paracentesis
  1. Secure consent, check V/S
  2. Let the patient void before the procedure to prevent puncture of the bladder
  3. Check for serum protein. Excessive loss of plasma protein may lead to hypovolemic shock.
Lumbar Puncture
  1. Obtain consent
  2. Instruct client to empty the bladder and bowel
  3. Position the client in lateral recumbent with back at the edge of the examining table
  4. Instruct client to remain still
  5. Obtain specimen per MDs order


References:
J.Q. Udan, RN, MAN 2004. Mastering Fundamentals of Nursing 2nd ed. Educational Publishing House

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